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You Are What You Eat
No full textThe author submitted this entry in the Creative Non-Fiction category (Amateur division) for the 2023 On My Own Time (OMOT) Art Show.Initially inspired by my own family's struggle with physical health, this piece is further driven by my reflections on the role that physicians can play in promoting healthy lifestyles
Unique Aspects of Intestinal Biology That Influence Enteric Virus Infection
Get PDFEnteric viruses are human pathogens that pose a significant global health problem. In this work, I explore how unique facets of host biology influence enteric virus infection, ranging from intestinal microbiota to circadian rhythms. To examine these factors, I used coxsackievirus B3 (CVB3) and poliovirus, which serve as a powerful model viruses to understand virus-host interactions. CVB3 and poliovirus are nonenveloped single-stranded positive-sense RNA viruses, which spread through the fecal-oral route. While many enteric virus infections are mild, some can be severe or even fatal. Thus it is important to study which factors impact enteric virus infection.
Throughout my dissertation I used a variety of mouse models to answer a multitude of questions related to what factors influence enteric virus infection. To study the microbiota-mediated enhancement of CVB3 infection, I used different methods of antibiotic depletion in mice. We determined that two related enteric viruses, CVB3 and poliovirus, differ in their requirements of the microbiota. Furthermore, I studied the antiviral effects of antibiotics in vitro and in vivo and found that while antibiotics are not antiviral for CVB3 in cell culture, they are antiviral for CVB3 in a mouse model. Finally, by infecting mice at different times of day, we determined that host circadian rhythms influence enteric virus susceptibility.
In conclusion, using model enteric viruses, such as CVB3 and poliovirus, I elucidated multiple unique aspects of host biology, ranging from microbiota to circadian rhythms, that influence viral replication and pathogenesis
Building and Deploying a Cloud Environment for Hosting Custom Application Development Services Within an Academic Tertiary Center
No full textPoster session at the Texas Health Informatics Alliance (THIA) 2023.The 2023 Texas Health Informatics Alliance Conference was hosted by the UT Houston School of Biomedical Health Informatics in Houston, Texas, on September 15, 2023.SIGNIFICANCE: The 21st Century Cures Act (Cures Act) is designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. Patients can now access their health information including radiology or pathology reports in near real-time. However, a few tools exist to allow patients to interpret these findings.
OBJECTIVE: To design an application that enhances patient understanding of diagnostic descriptions by translating medical reports into lay terms. As well as, building and hosting an environment for custom application development services in our academic center.
METHODS: We developed a web-based application in java that utilizes open AI to translate medical reports to layman terms. Posteriorly, we deployed our application within Microsoft Azure by building a static web app resource. Subsequently, through Visual Studio Code which was connected to our GitHub account. We downloaded an extension specifically designed to work with Azure to build and deploy static apps. By doing so, we were able to set up an authentication function that only allows access within our hospital network.
RESULTS: The application can successfully translate medical jargon into layman terms and the deployment in azure enabled us to implement real-time changes whenever we pushed modifications in GitHub.
CONCLUSIONS: The project was a proof of concept to demonstrate the possibilities of leveraging our organization's cloud services for development and hosting purposes. This demonstration serves as an illustration of the broader potential we have for building and hosting applications that can drive development towards a more patient-focused healthcare system within our hospital. By doing so, we facilitated a playground for medical professionals to develop meaningful tools that can bridge the gap between patients understanding and diagnostic information.
KEYWORDS: Web-based applications; cloud services; digital technologies
Structural competency: new frameworks to understand and respond to inequities in health
Get PDFTuesday, April 11, 2023; noon to 1 p.m. (Central Time); via Zoom. "Structural Competency: New Frameworks to Understand and Respond to Inequities in Health". Seth M. Holmes, Ph.D., M.D., Chancellor's Professor, Division of Society and Environment, Department of Environmental Science, Policy, and Management and the Joint Ph.D. Program in Medical Anthropology, University of California - Berkeley and San Francisco.Research on disparities in health and in medical care demonstrates that social, economic, and political inequities are key drivers of poor health outcomes. The influence of such inequities on health has long been noted by clinicians and public health practitioners, but such content has been incorporated unevenly into clinical training and clinical ethics. Recently proposed by clinicians, ethicists, and medical social scientists, the framework of "structural competency" offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. This lecture will cover key terms and primary domains of structural competency to allow medical practitioners, ethicists, and researchers to perceive and respond to social inequities in health in new ways.UT Southwestern--Program in Ethic
A Multisite Qualitative Analysis of Barriers and Facilitators to Adopting Tenecteplase
Get PDFQualitative study utilizing hermeneutic cycling and thematic analysis to explore the barriers and facilitators to adopting tenecteplase for stroke treatment. This was done through a series of interviews with neurovascular physicians and nurse stroke coordinators throughout Texas hospitals.This poster was presented at the 9th Annual Neuro and Intensive Care: Review, Workshops and Controversies 2023 in Orlando, Florida, on May 11, 2023.INTRODUCTION: Tenecteplase (TNK) is an emerging treatment for acute ischemic stroke (AIS) being adopted in place of alteplase (ALT). Compared to ALT, TNK has a longer half-life, shorter administration time, lower cost, and similarly high efficacy in treating large vessel occlusion. Nevertheless, there are barriers to TNK adoption as a treatment for AIS.
OBJECTIVES: The objective of this study is to identify thematic barriers and facilitators to TNK implementation at hospitals within the state of Texas.
MATERIALS & METHODS: This qualitative research study uses a phenomenological approach with hermeneutic cycling. After initial question development, subsequent questions were identified during each hermeneutic cycle in preparation for the next interview. Using purposive sampling, we interviewed stroke coordinators and physicians associated with the Lone Star Stroke Research Consortium, a statewide research network in Texas. The consortium is comprised of participants from 6 hub hospitals and 28 spoke hospitals including both community-based facilities to Comprehensive Stroke Centers. Interviews lasting 20-40 minutes were recorded and transcribed verbatim. Transcribed material was dissected and grouped into cohesive themes. Each stage of thematic analysis required consensus from the research team to proceed to the next interview. Sampling ended when saturation was reached.
RESULTS: Saturation was reached after four interviews. Three themes and eight sub-themes were identified. The theme Evidence had three sub-themes: Pro-Con Balance, Fundamental Knowledge, and Pharmacotherapeutics. The theme Process flow had four sub-themes: Proactive, Reflective self-doubt, Change Process Barriers, and Parameter Barriers. The theme Consensus had one sub-theme: Getting Buy-In.
CONCLUSION: Through qualitative interviewing, we identified themes and sub-themes in an effort to understand barriers and facilitators faced by hospitals when transitioning from ALT to TNK. The next study will use implementation science techniques and will involve designing an implementation toolkit informed by the data from this study. It is anticipated that this toolkit will be used in a prospective interventional block randomized study
The Capabilities of Neural Systems Depend on a Hierarchically Structured World
Get PDFThe study of the human mind spans thousands of years, from the earliest philosophers to modern neuroscience. However, there still remains an incredible gap in our understanding of how cognitive functions arise from the biology of the brain. This has greatly hampered attempts to understand how the brain works, what its limitations are, and how to replicate it in artificial intelligence systems. Here I propose a general framework to understand how cognitive processes can be encoded by networks of interconnected neurons. I have taken a theoretical and computational approach, using artificial neural networks as a high-level quantitative model of basic neuroscientific principles. Neural networks are capable of reasoning by means of a series of specialized distinctions made by individual neurons that are integrated hierarchically. This framework enables the study of how the capabilities of neural systems are dependent on structural and functional constraints. Biological constraints on neural coding and network size and topology limit the complexity of stimuli that can be comprehended by the network. Surprisingly, though, neural networks are capable of comprehending much more complex stimuli than has been previously described, provided that the inherent distinctions between these stimuli are hierarchically structured. Functional constraints on neural networks require that they be able to perform cognitive processes and be able to reason in a way that can be communicated with other people. I have proposed a novel neurocognitive model which, when implemented in deep neural networks, is able to simulate a wide variety of cognitive processes. It is consistent with experimental evidence from neuroscience and theories from philosophy and psychology. By directly implementing symbolic reasoning within the structure and function of the network, it becomes possible to overcome many of the fundamental problems that face modern artificial intelligence systems, including their lack of explainability, robustness, and generalizability. This culminated in a novel algorithm that translates neural networks to human-understandable code, providing a complete picture of how neural networks can reason. All of these results suggest that neural systems require the world to be hierarchically structured in order to comprehend it, a direct reflection of their own hierarchical organization
Investigating Resource Utilization in Elective Spine Patients with Affective Disorders: A Retrospective Analysis of a Cohort of 1199 Elective Spine Patients
Get PDFBACKGROUND: In elective spine surgery patients, affective disorders (ADs) are associated with increased preoperative opioid use to control pain, longer length of hospital stays, and increased postoperative readmission rates. When assessing healthcare resource utilization, how ADs influence perioperative electronic patient portal (EPP) communication with care providers has not been explored. It is also unclear how ADs influence in-patient and postoperative opioid consumption.
OBJECTIVE: To investigate the resource utilization of patients with ADs in our population by analyzing the relationship between AD and both perioperative EPP communication, opioid use, and surgical outcomes.
METHODS: The records of 1199 consecutive adult patients who underwent elective spinal surgery between January 2010 and August 2017 at a single institution were retrospectively reviewed for analysis. Primary outcomes included the number of perioperative EPP messages sent, perioperative narcotic use, rates of peri-operative complications, hospital length of stays, Emergency Department visits within 6 weeks, and readmissions within 30 after surgery. In the subanalysis, patients with patient-reported outcome measures for pain, anxiety, and depression within 30 days prior to surgery were used to assess whether preoperative narcotic use correlated with reported preoperative pain levels.
RESULTS: Patients with an AD were more likely to take narcotics before surgery and to have active EPP accounts compared to controls. They were also more likely to send postoperative messages, and tended to send more messages. The AD group had higher rates of postoperative complications, ED visits, and readmissions postoperatively. The AD group also requirement more opioid in the inpatient setting and were more likely to refill prescriptions for opioid medications 3- and 12-months after surgery. In the subanalysis, the average rating of pain intensity was notably higher in the AD group; however, there was no statistically significant difference in rates of narcotic use between low- and high-pain cohorts. This was not the case for the control group.
CONCLUSION: AD patients have increased EPP communication, perioperative opioid use, and postoperative complications. Addressing these concerns early and advocating for resources for this population may prevent more serious morbidity, reduce costs, address the opioid crisis, and improve patient care
Efficacy of Botswana's National Cancer Treatment Strategy: A Preliminary Analysis of Radiation Therapy in Breast Cancer Patients
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.BACKGROUND: Breast cancer is a significant threat to public health in low- and middle-income countries (LMIC) globally, with the observation of an alarming increase in incidence in sub-Saharan Africa. Radiation Therapy (RT) is an essential component of breast cancer treatment and many LMIC currently lack access to RT. In Botswana, cancer care for citizens is paid for by the government, which has resulted in a unique investment in RT compared to other countries in the region. However, breast cancer mortality remains high, warranting further investigation into patient access to and receipt of RT.
OBJECTIVE: This project seeks to investigate and present preliminary data on the percentage of breast cancer patients in Botswana qualifying for RT who actually went on to initiate RT. Demographic and clinical characteristics of breast cancer patients in Botswana are also presented.
METHODS: Demographic, clinical, and treatment information was collected prospectively on all breast cancer patients presenting to the Breast Multidisciplinary Team (MDT) clinic at Princess Marina Hospital (PMH) in Gaborone, Botswana from January 2015 to October 2020. Patients with incomplete treatment information were excluded from the analysis. Patients who should have received RT were identified based on National Comprehensive Cancer Network (NCCN) guidelines.
RESULTS: A total of 131 patients were included in the analysis. Of these, 29.8% were HIV-positive and 77.5% presented with advanced-stage disease. The vast majority of patients underwent mastectomy, and only 35% received chemotherapy. Based on NCCN guidelines, 121 patients qualified for receipt of radiation. In this population of breast cancer patients in Botswana, 92.6% of patients who needed RT received it.
CONCLUSION: Based on this preliminary analysis, the investment of Botswana's Ministry of Health in RT for its citizens is seeing encouraging success among breast cancer patients. This analysis was limited by incomplete treatment information on the majority of breast cancer patients in this cohort, limiting the sample size in the final analysis. Further study is needed to characterize completion of RT in this population and factors that affect this
Mind the gap: stepping on a bridge of life
Get PDFDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern's Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin
State policy responses to substance use in pregnancy and mother-infant outcomes
Get PDFTuesday, May 9, 2023; noon to 1 p.m. (Central Time) "State Policy Responses to Substance use in Pregnancy and Mother-Infant Outcomes". Laura J. Faherty, M.D., M.P.H., M.S.H.P.; Physician Policy Researcher, RAND Corporation; Professor of Policy Analysis, Pardee RAND Graduate School; Associate Director, Barbara Bush Children's Hospital Scholars at Maine Medical Center; and Assistant Professor of Pediatrics, Tufts University School of Medicine.The opioid crisis has had a substantial effect on pregnant women, with the number of pregnant women with an opioid use disorder diagnosis at delivery quadrupling from 1999 to 2014, and the incidence of neonatal opioid withdrawal syndrome increasing nearly seven fold from 2000 to 2014. The speaker, a clinician-researcher with extensive experience for this population, will discuss (1) the evolution of state policies related to substance use in pregnancy over the past two decades, (2) her research on the effects of these policies on the mother-infant dyad, (3) the rapidly-growing evidence base on the harmful impacts of punitive policies towards substance use in pregnancy, and (4) future research directions and opportunities to improve care for maternal-infant dyads affected by opioid use in the perinatal period.UT Southwestern--Program in Ethic